Healthcare Provider Details

I. General information

NPI: 1770834160
Provider Name (Legal Business Name): TARA FAMILY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 NICKLAUS CIR
TAMPA FL
33624-4541
US

IV. Provider business mailing address

730 S STERLING AVE SUITE 301
TAMPA FL
33609-4542
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-1111
  • Fax:
Mailing address:
  • Phone: 813-877-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMT1692
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5467
License Number StateFL

VIII. Authorized Official

Name: JEAN MULLOY
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 813-877-1111